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Utah rates for HCPCS Q4158

Kerecis Omega3, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.04 / $78.04 / $78.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $74.00 / $84.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.12 / $99.65 / $114.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $67.27 / $67.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.59 / $74.00 / $74.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $67.27 / $67.27